Category Archives: public understanding of science

Members of the media, and perhaps all of us, are fascinated with the idea of people staying awake, or finding themselves awake, during surgery.

The New York Times recently published a story about the phenomenon of patients asking to stay awake and alert during surgeries.

Now the thought of staying awake during surgery makes many of us squirm. Think about how it feels to watch yourself or someone else take a splinter from your finger. Or your toe.

If your surgeon told you that being awake or unconscious would have no impact on your surgical outcome, would you opt to stay awake?

Wide awake surgery is not new. Women routinely have caesarean sections while under local anesthetic and some complete brain surgeries involve keeping the patient awake to test their responses.

What is new is being given the choice. If your surgeon told you that being awake or unconscious would have no impact on your surgical outcome—would you opt to stay awake?

Being a spectator at your own surgery then becomes like any other event in your day, like watching television or cleaning out the cat’s litter box. You pick up a loaf of bread at the bakery, then stop by to see your hernia repaired.

The matter-of-factness of awake surgery is the tone of the New York Times story. At one point in the article, “As he scraped, Dr. Ilyas chatted with Ms. Voynow, trying to keep her calm. From a sound system, the Temptations crooned along, with “The Way You Do the Things You Do…” Life in the operating theatre could simply not get more mundane and less curious.

It almost makes you wonder why this is news.

But it is. Because, as the story goes on to tell, the phenomenon of wide awake surgery is gaining ground. Recovery without anesthetic is faster, costs are lower and patients feel more in control.

The reasons behind people wanting to stay awake during surgery, as reported here, are several. Distrust for authorities is growing and people want to keep their eye on someone they have allowed to cut into their bodies.

However, most patients are simply curious. They want to watch the surgery to see how it’s done, a fascination made more acute and bearable through the graphic surgeries increasingly shown on television and online.

Some surgeons, it would seem, are increasingly not only accepting but likely pleased that their patients are joining with them in appreciating their handicraft. Other surgeons, the story says, are not as keen on wide-awake surgery, fearing litigation or criticism.

Most interestingly, surgeons are having to attend to the side of humans they rarely need to worry about in the operating theatre—the psychosocial part of dealing with people. Doctors in these wide-awake surgeries need to figure out how to have small talk for three hours with a patient whose boredom may result in their blood pressure rising or them having an unsatisfactorily dull medical experience.

Surgeons and their staff are also having to think on the charm offensive about the language they use in surgeries, so as not to alarm their awake patients with off-handed or everyday expressions common in any field of operations.

This story reminds us that perhaps the idea of “operating theatre” is becoming more like a giant selfie, where the camera turns the lens or at least the performance adds the protagonist to the audience.

As interesting and positive as the New York Times story is, we should consider that other recent news coverage flips quickly towards the negative side of being awake during surgery.

A BBC story is one of many whose news hook surrounds the macabre idea of accidentally waking up during surgery—when you intended to blissfully sleep through it.

The news in this story centers around medical mistakes, when patients are not given enough drugs to stay unconscious during an entire surgery. Worst yet, as the story describes, people wake up during surgery are unable to move and signal their status because of the muscle relaxants they were given.

In the BBC story, they report on a study from the Royal College of Anaesthetists and Association of Anaesthetists of Great Britain and Ireland. They studied three million operations over a period of one year and found than 150 people a year reported being conscious during surgery after being given general anesthesia. They reported that this happens once in every 19,000 operations.

Let’s consider these statistics for a moment.

First, the numbers reported in this story are dizzying and baffling. We first read that 150 people were conscious during surgery in a year. We next read that one in 19,000 people will wake up. That sounds like pretty good odds.

The story is telling us that when you undergo surgery under anesthesia in the UK or Ireland, you have a .005 percent chance of waking up. These are the same odds as dying from a venomous snake or lizard bite in the U.S.

Think of it this way: you are four times more likely to die from being hit by lightning than waking up during surgery.

The centerpiece of the BBC story is the tale from an anonymous patient who woke up during orthodontic surgery at the age of 12 and could “hear voices around me and I realized with horror that I had woken up in the middle of the operation but couldn’t move a muscle. While they fiddled, I frantically tried to decide whether I was about to die.”

Fifteen years later, the patient told researchers, she had nightmares of monsters leaping out to paralyze her.

Such stories build one more piece of uncertainty in those getting ready to have surgery. Add waking up during surgery and not being able to tell anyone to the list of worrying about blood loss, what doctors will find, how long it will take for you to recover and if you might die.

Between The New York Times story about people wanting to stay awake during surgery and the BBC story about people accidentally waking up, you would think that states of consciousness in operating theatres is a new hot topic.

In fact, the idea of the public bearing witness to surgery is not new.

The Old Operating Theatre in the garret of St. Thomas’s Church in Southwark, London, one of the oldest surviving operating theatres.

In most cases, as hospitals were built in the 18th century, the public was shut out of these public surgeries because the theatres were already packed with medical students. Of course, if the gallery was full and you needed something to do, you could just attend a public hanging and execution. Or read about the surgery in your local newspaper.

But in the 20th century, the operating theatre became a private affair. More was known about controlling contaminants which gave surgeons a cozy excuse to excuse outsiders from the serious business of surgery.

From the early days of public observation, to the closed doors of the 20th century, and the recent broadcasting of surgeries, the idea of people watching themselves going under the knife seems like the next, logical step.

And perhaps those who fear unexpectedly waking up should simply consider not going under in the first place.